Abdominal sepsis: efficacy of passive immunotherapy

Background

Owing to immune disorders playing a key role in development of systemic inflammatory response syndrome, passive immune therapy is considered a method of choice for abdominal sepsis (AS) patients. Existing remedies (specific hyperimmune serum, specific antibodies and immunoglobulins) are expensive and require exact validation of pathogens. The aim of the study was to evaluate the efficacy of using the AS reconvalescent donor plasma for passive immunotherapy of AS.

Materials and methods

The study was conducted experimentally on 775 Wistar line rats and 38 inbreed dogs. A total of 296 patients with AS were also involved in the study; 58 formed the control group; 26 patients were selected as reconvalescent donors of plasma. Serum concentrations (ELISA) of major antibodies were determined against most significant pathogens (Escherichia coli, Staphylococcus spp., Staphylococcus aureus, Bacteroides spp., Klebsiella pneumoniae, Pseudomonas aeruginosa).

Results

Changes of serum antibody concentrations were time dependent and fluctuating during the current of AS forming the waveform curve. Most remarkable decreases were found during 24–72 hours of AS. Serum antibody titers to the main pathogens were slightly higher due to antibiotics and detoxification therapy. Operation by itself decreased titers from 4.42 ± 0.28 to 3.49 ± 0.25 (E. coli), and from 5.41 ± 1.02 to 3.0 ± 0.58 (P. aeruginosa). Anti-staphylococcal antibody titers decreased from 7.22 ± 0.9 before surgery to 4.83 ± 0.47 after. Repeated operations alter antibody concentrations even more significantly. The highest levels of antibodies were found in patients who underwent successful treatment of AS 1–2 months prior to investigation. Their plasma was used in treatment of AS patients. Intravenous administration of two-dose 100–200 ml hyperimmune plasma per day prevented a following decrease of antibody levels, and in 98% of cases increased them (21.39 ± 1.47%). The cost of treatment was 15–37% lower if compared with traditional methods (control group).

Conclusion

There is exact evidence of efficacy for using hyperimmune plasma in patients with abdominal sepsis; it is more cost-effective if compared with traditional methods of immunotherapy.